Provider Demographics
NPI:1033143417
Name:BAKER, IRENE T (NP)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:T
Last Name:BAKER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1540 LAKE LANSING RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-3756
Mailing Address - Country:US
Mailing Address - Phone:517-913-3910
Mailing Address - Fax:517-913-3911
Practice Address - Street 1:1540 LAKE LANSING RD
Practice Address - Street 2:SUITE 205
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-3756
Practice Address - Country:US
Practice Address - Phone:517-913-3910
Practice Address - Fax:517-913-3911
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704111052363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1024246OtherMCLAREN HEALTH ADVANTAGE
MI5008769750OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI1033143417Medicaid
MI7272662OtherAETNA
MI200000001200OtherPHP
MI0N55170009OtherMEDICARE PLUS BLUE
MI200000001200OtherPHP FAMILYCARE
MI1024246OtherMCLAREN HEALTH PLAN-COMMERCIAL
MI1024246OtherMCLAREN HEALTH PLAN-MEDICAID
MI1024246OtherMCLAREN HEALTH ADVANTAGE
MI1024246OtherMCLAREN HEALTH PLAN-COMMERCIAL